In particular, Hyperbaric Oxygenation Treatment (HBOT) is widely used for wounds with healing problems. Among them, we can mention burns, diabetic foot and chronic peripheral vascular obstruction. Wounds and injuries with vascular compromise generate irrigation problems, ischemia and hypoxia conditions.
HBOT for diabetic foot is indicated for wounds that meet an established classification (Wagner grade 3 or higher) with certain characteristics (an ulcer that penetrates tendon, bone or joint, presents abscess or gangrene and has not shown measurable signs of healing).
It is postulated that the HBOT would allow increasing the oxygenation of the hypoxic tissues, favoring their healing. HBOT acts to favor wound healing through tissue hyper-oxygenation, vasoconstriction, fibroblast activation, inhibition of inflammatory cytokine production and release, stimulation of growth factors and neovascularization, antibacterial effect, the formation of granulation tissue, the potentiation of the antibiotic effect and the reduction of leukocyte adhesion.
The pro-angiogenic effect is favored by the action of HBOT on regional growth factors (VEGF), on the recruitment and differentiation of circulating stem/progenitor cells and on the production of extracellular matrix. In addition, in the case of diabetic patients, HBOT helps in the peripheral use of glucose.
In all types of diabetic ulcers in the feet or hands, a significant increase in PtcO2 after the application of HBOT indicates an increased likelihood of viability of the affected limb. It should be noted that HBOT is well tolerated and provides benefits to the quality of life of the patient, both by decreasing the number of hospital admissions and the morbidity of these patients.
In addition, its cost-effectiveness is widely documented, considering the reduction in treatment costs, in the hospital stay, in the risk of amputations and the improvement in the productivity of patients affected by diabetic foot.
Numerous clinical trials have been carried out to evaluate the effects of HBOT in patients with diabetic foot. The results of multiple studies in a significant number of patients showed a high success rate in patients refractory to other treatments, highlighting the adjuvant role of HBOT for deep chronic wound infected in patients with diabetes mellitus and non-diabetic patients (venous ulcers, arterial and pressure ulcers).
For venous ulcers, reduced wound size was observed. These results should be extended with subsequent trials of high methodological rigor and, in addition, define those patients who can obtain more and greater benefits of HBOT.
In acute wounds, such as burns, grafts and implants, it was found that the incorporation of HBOT favors and accelerates healing, reduces the need for additional surgical procedures and tissue necrosis, with respect to routine treatment. In these wounds, HBOT also reduces morbidity and mortality, shortens the hospital stay and improves the quality of life of patients.
HBOT reduces mortality and amputation rate in necrotizing infections (Fasciitis, Fournier gangrene, gas gangrene) as adjuvant therapy with antimicrobial therapy and emergency debridement. In these pathologies with a commitment to life, HBOT is indicated in an absolute way and its application must be immediate.
HBOT is also effective for the treatment of infections that compromise the bone, difficult to access and for the antibiotic to reach the bone tissue. In the course of pathologies such as osteomyelitis, the tissue pO2 is very low, due to trauma, vascular compromise and fibrosis.
The use of HBOT increases the pO2 necessary for neovascularization, reversing ischemia, accelerating healing, inhibiting the growth of anaerobic microorganisms and stimulating the phagocytic action of leukocytes in tissues, promoting osteogenesis and activation of osteoclasts in the removal of bone detritus.
Thanks to the adjuvant therapy of HBOT, a complete eradication of the infection is observed, demonstrating its efficacy in the management of chronic refractory osteomyelitis, favoring the success of conventional clinical and surgical treatments.
Dr. Mariana Cannellotto and Biochemistry Liliana Jordá.
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